Table 3.

Aim, main results, and conclusions of included studies for this systematic review.

References	Symptoms	Aim	Inclusion criteria	Exclusion criteria	Main results	Conclusions	Adverse events
Nielsen et al. (22)	Severity of lower limb spasticity	To explore whether rPMS can improve spasticity in patients with MS.	(1) Clinical definite MS (2) Neurological condition for at least 6 months (3) Severity of lower limb spasticity (4) Preserved walking performance for 10 m	(1) Epilepsy, other neurological disorders, pregnancy and implanted spinal metal, drug infusion pump and pacemakers (2) Received magnetic stimulation previously	AS↓, EMG-, Self-Ease Score-	rPMS has an antispastic effect in MS.	No side effects
Krewer et al. (23)	Severe hemiparesis and mild to moderate spasticity	To investigate effects of rPMS on spasticity and motor function.	(1) Hemiparesis caused by stroke or TBI (2) Spasticity of an upper extremity with a score of 1–3 on the MTS (3) Ages between 18 and 75 years	(1) Metal implant in the head or within the stimulation area (2) Pregnancy and cardiac pacemaker, cochlea implant, or medication pumps (4) Comorbidity with neurodegenerative or orthopedic disorders (5) Increased intracranial pressure (6) Unstable fractures of the paretic upper extremity	MTS↓, MAS-, HAMD-	rPMS increase sensory function in patients with severe limb paresis in patients with CNS lesion. It has limited effect on spasticity and no effect on motor function.	No side effects
Serag et al. (20)	Spasticity and painful cramps in the lower extremities	To test the effectiveness of rPMS in decreasing spasticity and painful cramps in the lower extremities of patients with MS.	(1) MS diagnosis was made according to McDonald's criteria 2010 (2) EDSS score was less than or equal 6.5 (3) Spasticity grade 1+, 2, or 3 according to MAS (4) Refractory to oral medications for at least 3 months	(1) Fixed contractures were excluded as well as pregnant ladies (2) Implanted pacemakers or metallic devices	MAS↓, 25 Foot Walking Test-, Frequency and intensity of spasticity↓	rPMS has an antispastic effect in MS.	No side effects
Beaulieu et al. (24)	Chronic stroke patients with ankle impairments.	To explore whether rPMS could mediate improvements in corticomotor and clinical outcomes associated with ankle impairments in chronic stroke.	(1) Participants with stroke presented with paretic ankle muscles with spasticity (2) CT or MRI scan taken within the last 5 years (3) Walk independently (i.e., no physical assistance) more than 10 m with or without an assistive device	(1) The use of anti-spastic medication (2) Past vertebral surgery, major circulatory, respiratory or cardiac disease, neurological disease/deficit other than stroke (3) Severe lower limb orthopedic conditions, or cognitive disorder	ROM↑, CME↑, Strengthen↑, plantar flexor resistance to high-speed stretch↓	rPMS improved ankle impairments in chronic stroke patients.	No side effects
Werner et al. (25)	Chronic patients after CNS lesion with a severe wrist and finger flexor spasticity	To assess the effect of a single session of rPMS combined with manual stretch on wrist and finger flexor muscle spasticity.	(1) Patients with a single history of CNS lesion due to stroke or traumatic brain injury (2) Lesion interval >12 months (3) Increased muscle tone, Ashworth Score (0–5) in wrist or finger joints	(1) Volitional distal motor function of the affected arm, except for mass flexion (2) Metal implants or /and open wounds in the stimulation area (3) Deep vein thrombosis (4) Relevant edema (5) Pacemaker (6) Preceding BTX injection within the last 6 months	MAS↓, Passive Extension Deficit↓	A single session of rPMS combination with manual stretch significantly reduced the wrist and finger flexor muscle spasticity in patients with CNS lesion.	No side effects
Chen et al. (19)	Spasticity (MAS ≥ 1)	To explore the EEG mu rhythm change and decrease in spasticity after rPMS intervention in patients with stroke.	(1) Ischemic or hemorrhagic stroke diagnosed through computed tomography or MRI (2) Age in the range of 18–80 years (3) At least 2 weeks since stroke onset (4) Spasticity (MAS ≥ 1) (5) Ability to sit on a chair independently for at least 1 h	(1) Cardiac pacemaker (2) Pregnancy (3) Allergy to EEG electrode cream (4) Joint contracture in the hand or upper limb (5) Unstable fracture in the paretic upper limb	MAS↓, MTS↓, FMA↑	rPMS can reduce spasticity	No side effects
Jiang et al. (21)	No practical arm function within four weeks of a first stroke.	To investigate the effect of rPMS applied in early subacute stroke on severe upper extremity impairment.	(1) First-ever unilateral ischemic or hemorrhagic stroke in the basal ganglia with a course of 1–4 weeks (2) Medically stable (3) Age 30–80 years (4) A Brunnstrom stage of 1 to 2 for the upper limb and hand (5) Ability to provide written informed consent	(1) Severe spasticity (MTS>3) (2) Severe aphasia or cognitive impairment (3) Infection near the stimulation site (4) Deep-vein thrombosis near the stimulation site (5) Unstable fractures of the paretic upper extremity (6) Any contraindications to rPMS (e.g., metal implants in the affected limb or use of a pacemaker) (7) BTX injection, anti-spastic medicine	FMA↑, BI ↑	rPMS can improve arm function and muscle strength for grip and elbow flexion and extension.	No side effects
Nahas et al. (26)	Limb spasticity secondary to various neurological disorders	To investigate whether piTBS will reduce spasticity when applied directly on spastic muscles.	(1) Age more than 18 years, disease duration>6 months with persistent spasticity in the affected muscle and no change in anti-spasticity medications for at least 1 month prior to recruitment	(1) Recent BTX injection (< 4 months) (2) Metal plates, pacemakers, pregnancy	MAS↓, eBTD↓	piTBS could be a promising method to reduce spasticity and BTX in patients with CNS lesion.	No side effects

BI, Barthel Index, BTX, Botulinum toxin, CNS, central nervous system, CT, computerized tomography, EEG, electroencephalography, FMA, Fugl–Meyer Assessment, MAS, Modified Ashworth Score, MS, multiple sclerosis, MTS, Modified Tardieu Scale, MRI, magnetic resonance imaging, piTBS, peripheral intermittent theta burst stimulation, ROM, range of motion, CME, corticomotor excitability, rPMS, repetitive peripheral magnetic stimulation, TBI, traumatic brain injury, eBTD, estimated Botulinum toxin dose.